Healthcare Provider Details

I. General information

NPI: 1497703243
Provider Name (Legal Business Name): YAVAPAI CHIROPRACTIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 N WINDSONG DR SUITE B1
PRESCOTT VALLEY AZ
86314-1208
US

IV. Provider business mailing address

3075 N WINDSONG DR SUITE B1
PRESCOTT VALLEY AZ
86314-1208
US

V. Phone/Fax

Practice location:
  • Phone: 928-775-8750
  • Fax: 928-775-8750
Mailing address:
  • Phone: 928-775-8750
  • Fax: 928-775-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7620
License Number StateAZ

VIII. Authorized Official

Name: DR. THOMAS LEWIS SANIO
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 928-775-8750